stack/tests/pfs/test_elements.py

"""pfs.elements — closed element vocabulary + deterministic descriptor parse."""

from __future__ import annotations

from pfs.elements import (
    VOCAB,
    Element,
    ElementType,
    is_element_paragraph,
    parse_descriptor,
    slug,
)

CCM_99490 = (
    "Chronic care management services, at least 20 minutes of clinical staff time "
    "directed by a physician or other qualified health care professional, per calendar "
    "month, with the following required elements: multiple (two or more) chronic "
    "conditions expected to last at least 12 months, or until the death of the patient; "
    "chronic conditions place the patient at significant risk of death, acute "
    "exacerbation/decompensation, or functional decline; comprehensive care plan "
    "established, implemented, revised, or monitored."
)
G2058 = (
    "Chronic care management services, each additional 20 minutes of clinical staff time "
    "directed by a physician or other qualified health care professional, per calendar month "
    "(List separately in addition to code for primary procedure). (Use G2058 in conjunction "
    "with 99490). (Do not report 99490, G2058 in the same calendar month as 99487, 99489, 99491)"
)
APCM_G0556_STEM = (
    "Advanced primary care management services provided by clinical staff and directed by a "
    "physician or other qualified health care professional who is responsible for all primary "
    "care and serves as the continuing focal point for all needed health care services, per "
    "calendar month, with the following elements, as appropriate:"
)


def _has(elements, type_, value, detail=None):
    return any(
        e.type == type_ and e.value == value and (detail is None or e.detail == detail)
        for e in elements
    )


class TestVocab:
    def test_every_type_has_values(self):
        for t in ElementType:
            assert VOCAB[t], t

    def test_values_are_slugs(self):
        for values in VOCAB.values():
            for v in values:
                assert v == v.lower() and " " not in v, v


class TestTimeAndPeriod:
    def test_first_20_minutes_per_calendar_month(self):
        els = parse_descriptor(CCM_99490)
        assert _has(els, ElementType.TIME, "first", "20")
        assert _has(els, ElementType.PERIOD, "calendar-month")

    def test_each_additional(self):
        els = parse_descriptor(G2058)
        assert _has(els, ElementType.TIME, "each-additional", "20")

    def test_per_30_days(self):
        els = parse_descriptor(
            "Chronic care management, at least 20 minutes, per 30 days"
        )
        assert _has(els, ElementType.PERIOD, "30-days")


class TestActorAndPopulation:
    def test_clinical_staff_directed(self):
        els = parse_descriptor(CCM_99490)
        assert _has(els, ElementType.ACTOR, "clinical-staff-directed")

    def test_personally_by_physician(self):
        els = parse_descriptor(
            "Chronic care management services, provided personally by a physician or other "
            "qualified health care professional, at least 30 minutes, per calendar month"
        )
        assert _has(els, ElementType.ACTOR, "physician-or-qhp-personally")

    def test_two_or_more_chronic_conditions(self):
        els = parse_descriptor(CCM_99490)
        assert _has(
            els, ElementType.POPULATION, "multiple-chronic-conditions-12-months"
        )
        assert _has(els, ElementType.POPULATION, "significant-risk")


class TestActivityAndRelation:
    def test_care_plan_activity(self):
        els = parse_descriptor(CCM_99490)
        assert _has(els, ElementType.ACTIVITY, "comprehensive-care-plan")

    def test_addon_and_exclusions(self):
        els = parse_descriptor(G2058)
        assert _has(els, ElementType.RELATION, "addon-of", "99490")
        for code in ("99487", "99489", "99491"):
            assert _has(els, ElementType.RELATION, "not-with", code)
        assert _has(els, ElementType.BILLING, "list-separately")

    def test_apcm_stem_billing_and_actor(self):
        els = parse_descriptor(APCM_G0556_STEM)
        assert _has(els, ElementType.ACTOR, "clinical-staff-directed")
        assert _has(els, ElementType.PERIOD, "calendar-month")
        assert _has(els, ElementType.BILLING, "focal-point-all-primary-care")


class TestModality:
    def test_telecommunications(self):
        els = parse_descriptor(
            "Synchronous audio-video visit for the evaluation and management of a new patient, "
            "furnished using an interactive telecommunications system"
        )
        assert _has(els, ElementType.MODALITY, "interactive-telecommunications")
        assert _has(els, ElementType.MODALITY, "audio-video")

    def test_audio_only(self):
        els = parse_descriptor(
            "Telephone evaluation and management service, audio-only"
        )
        assert _has(els, ElementType.MODALITY, "audio-only")


class TestHelpers:
    def test_sorted_unique(self):
        els = parse_descriptor(G2058 + " " + G2058)
        assert list(els) == sorted(
            set(els), key=lambda e: (e.type.value, e.value, e.detail)
        )

    def test_element_paragraph_heuristic(self):
        assert is_element_paragraph("Consent;")
        assert is_element_paragraph(
            "++ Document in patient's medical record that consent was obtained."
        )
        assert is_element_paragraph(
            "Comprehensive care plan established, implemented, revised, or monitored)."
        )
        assert not is_element_paragraph(
            "Comment: Several commenters noted that the CPT Editorial Panel created a new code"
        )
        assert not is_element_paragraph(
            "Response: It is our preference to use CPT codes unless Medicare has a programmatic need"
        )
        assert not is_element_paragraph(
            "We proposed that HCPCS codes G0556 through G0558 would describe APCM services furnished per calendar month."
        )

    def test_slug(self):
        assert slug(Element(ElementType.TIME, "first", "20")) == "time=first:20"
        assert slug(Element(ElementType.ACTIVITY, "consent")) == "activity=consent"

    def test_enumeration_list_items_are_not_element_paragraphs(self):
        # C1: "( 9) 99439 (code for non-complex chronic care management)."
        # is a cross-reference enumeration item, not a fragment of 99439's
        # own descriptor, even though it ends in ")." like a real element
        # line. The still-accepted lines below must keep passing.
        assert not is_element_paragraph(
            "( 9) 99439 (code for non-complex chronic care management)."
        )
        assert not is_element_paragraph(
            "( 10) 99457 and 99458 (codes for remote physiologic monitoring)."
        )
        assert is_element_paragraph("Consent;")
        assert is_element_paragraph(
            "++ Document in patient's medical record that consent was obtained."
        )
        assert is_element_paragraph(
            "Comprehensive care plan established, implemented, revised, or monitored)."
        )